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FOR OFFICE US 4 Permit No. /5 -------------------- ------------------------------------ APPLICATION FOR SANITATION PERMIT f •---"- •- in Duplicate) ��` ---- --------------- (Complete , Date Issued -------.....---�-•-�.� -----_-------------- This Permit Expires 1 Year Proal Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and inshadl +(work here d scrbed. This application is made in compliance with County Ordinance No. 549. Ajc+ ✓LD- x Wey �------- JOB ADDRESS A OCATIO �__ ----------0. - - •-- " ---" '""" Owner s Name----- - - - - ---- - •------------- --- --- - ------- ------------------ --------- ------ -•- -----------•--.:-Phone------------------------------•----- _ r� Address----------- - .�_ '• ------ ---•----- ---------------------------------••--------------- "�G 4 Contractor's Name---------------------- --------------------- --•----------.............•............... o } -- ...... Ph ne .�-� •��-��• �f Installation wiii serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 6S- Number of living units: .____ Number of bedrooms - Number of baths _./_ Lot size Water Supply: Public system ❑ Community system ❑ Private 9 Depth To Water TableSAP ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel F1 Sandy Loam [I Clay Loam'' Clay [3Adobe❑ Hardpan El Previous Applicafion Made: (If yes,date--- -----) No ❑ New Construction: Yes E] No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) gel't nb: Distance from nearest well_--_--.---_-----Distance from foundation_---_____-----._--Material----.---_-_------------------------------------ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity------------•------- i Distance from nearest well_,!%'? .-------Distance from foundations l---...__.Distance to clearest lot lira_---- ---_- Number of lines-------- ___. Wid#h of trench.___a7 ___. ----r--- .----- - Length of each line-rial 6_ --------fes-- �{ Type of filter materia l. _- _.Depth of filter material-----_ __ Total leng#h________________________ s;!•-------- -Size: is ` ` Seepage Pit: Distance to nearest eII/QIQ'-._-_--Distanc m f hdation- ___a4__--.Distanc9.�to nearest lotine- -Size: i ne__ 1,�---.• Number of pits-----�-----------Lining material- .___- - _ meter----�-�.__.-----.D-pth--�,5i_------•------------- Cesspool: Distance from nearest well-----------------Distance from foundation.-..-.-----_-----_.Lining material--.-.--_----__._-- .-----._----...--- ❑ ----•-----------Li Liquid Capacity -__•-_--•-gals. Size: Diameter-------------------------------------Depth.---• --------------••----------- - q P tY---------...---- F Privy: Distance from nearest well-----------_-------_- --- ---Distance from nearest building-- ---------------------------•-- ❑ ----------•----------------------------- Distance to nearest lot ine----------------------------------------------- I Remodeiing and/or repairing [describe :----------------- ---------------- ------------------•---------------------•-•------•"------•------•------ --•--------------"-•--•-------•-------------- ----•-------------------•-------------------------------------------------- _------------_----------------------•------------------------------ ----- I hereby c ify at I have prepared this application and that the work will be done in accordance with San Joaquin County ardinanc S e S. and rule and regul ons of the San Joaquin Local Health District. 1 and/or Contractor) ( igSi reed -- -------- --------- - )---•- •- -- ----- ---- BY� Title ---- - --- -- ( qrver ------------- ---- ------- --------- (Plot plan, showing size of lot, location of system in re ation to wells, build' s, etc., can be placed ose side). FOR DEPARTMENT USE,ONLY APPLICATIONACCEPTED BY------------ - -- - ------------ -------------- --------------------------------------- DATE. REVIEWED BY DATE.----------------------------------------------------------- - ----- ------------------------- --------------------------- ---••-- -e------•---------._-DATE---•---•---------------_-------- --••---------------------- BUILDING PERMIT ISSUED-------------------------------------------------------- ----- Alterations and/or recommendations:-_---7 ------------ —------ --------------- x --------1-•--- --------••------------ ---------------------------------------------------------- c�'t� Date--- FINAL INSPECTION BY----------------------------------- ----.. / --------_--_-------------------•-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wed Oak Street 144 Sycamore Street 405 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5-62 ATLAS